The growing need for medical gas delivery systems is inevitable but the welfare of the patients and the medical personnel is important thus the need for strict compliance with safety standards, codes, and procedures is a must. Medical gas systems of the present time are sophisticated that the plumbing systems directly runs towards the area where the gas is administered to the patient or used in the procedure for the care of the patient(Lyczko). Anesthesia gas supplies are either delivered through these pipelines or gas cylinders.
Oxygen, air, nitrogen, and nitrous oxide are the common gases utilized in hospitals especially in medical operating rooms. The medical gas systems have the aforementioned gases as vital components of the exhaust vacuum for the scavenging or waste anesthesia gas disposal (WAGD). These gases needs to be properly monitored by the anesthesiologist as well as the gas machines to ensure that the patients are safe and free of dangers due to these gases(Morgan).
The most needed medical gas especially in surgical area is oxygen which is 99% or 99. 5% pure.
Manufacture of oxygen is through fractional distillation of liquefied air. It is either refrigerated as a liquid or compressed and stored in room temperature. Usually in small hospitals this gas is stored in two split banks of H-cylinders or high-pressure cylinders(Morgan). The most commonly used gas for anesthetic purposes is nitrous oxide which is manufactured through thermal decomposition or heating of the ammonium nitrate. Large H-cylinders that is connected to an automatic crossover feature thru a manifold is the customary storage place for nitrous oxide.
No elaborate system of refrigeration is feasible in keeping this gas liquefied because its critical temperature is 36. 5°C that is above room temperature(Morgan). Patients are not administered with nitrogen but this gas is a need in hospitals because it is utilized as power source of operating room equipments like drills and saws. H-cylinders with manifold serve as usual storage receptacle for this gas(Morgan). Air is widely used in anesthesiology procedures to prevent the occurrence of hazards due to nitrous oxide and high oxygen concentrations. Oxygen is mixed with nitrogen to produce a medical grade cylinder air.
The color codes used in USA for medical gas cylinders are as follows: green for oxygen; yellow for air; black for nitrogen; and blue for nitrous oxide(Morgan). The basic form of an anesthesia machine receives medical gases from the gas supply, reduce the pressure to control the flow of the needed gases, for safety it is able to vaporize into the final gas combination the volatile anesthetics, and thru breathing circuits that is attached to the patients airway gases are delivered(Morgan). Pressure gauges regulate the constant flow of alternating supply pressure.
The anesthesia machine is equipped with this regulators in cylinder and pipeline supplies to reduce the cylinder pressure to 45 per square inch gauge (psig) constant and when the pipeline supply of gas surpasses 45 psig it closes off the supply in the cylinder. The newest type of plumbing system is a centralized piped medical gas system that directly introduces the gases to the patients that needs the gases. This kind of system supplies the patients with the needed gases in a more safe way than those pressurized cylinders that are bulky and dangerous.
Regulation of the gases is easier due to centralized pumps, cylinder manifold systems or compressors. The National Fire Protection Association strictly implements that they will be the one to design and install this system(Lyczko ). Gas cylinders have standards that are formulated, created, and implemented by government agencies like Compressed Gas Association, Department of Transportation, American Society of Mechanical Engineers, and the National Fire Protection Association. The cylinder has the following parts: cylinder valve, safety relief device, hanger yoke, and check valve(Dosch ).
The use of gas cylinders is usually safe though it has the possibility of being a cause of a serious accident if not handled and used properly(Bojanowski ). Computing the gas contents of a cylinder is of significance in determining the duration of the supply of the gas to the patient specifically during transportation of patients. The most common H cylinder for oxygen contains 244 cubic feet while the E cylinder mostly contains 22 cubic feet. A tank factor is a unique constant factor used in the computation of gas content in the cylinders. The tank factor for E cylinder is 0. 28 liters per psi and for H cylinder 3.
14 liters per psi. The gas content is computed by multiplying the constant tank factor to the pressure which is indicated in the gauge. Given the rate of the flow of the gas, calculation for the duration in which the gas in the cylinder will last can be computed. One must keep in mind though that after the computed time has elapsed the cylinder will be totally empty thus an extra ga cylinder with contents should be prepared(White ). There is a prospective to create hazardous working environment due to compressed and liquefied gases thus guidelines on safe handling of cylinders must be followed.
Proper gas cylinder storage is required to prevent on toward accidents. Gas cylinders should be: stored in areas with adequate ventilation; avoid storage in – entrance and exit routes, damp areas, near corrosive chemicals or salts or fumes, areas exposed to weathers, and heat; stored in upright position; secured with cap when not used; belted appropriately above the midpoint or secured with wall brackets and stands; at least 20 feet from flammable areas or things; stored according to type of hazard class; cylinders without contents should be separated from empty ones; and stored not more than one year without using.
Only persons with proper training shall handle compressed and liquefied gases(Safety). Safety devices are available for further prevention of any leakage or accidents to happen. Among these devices are the sealing-type washers and the crush-type gaskets. But these devices have types that are not reusable that usually is the cause of cylinder explosions. It is thus advisable to use only sealing washers that are metal-bound elastomeric and avoid recycling the use of crush-type gaskets to prevent accidents(FDA ). Other safety devices are the DISS and the PIS.
DISS or diameter-indexed safety system or quick connect fittings are intended for pressures equal to or lower than 200 psi. This system avoids the switching of equipment that is intended for different gases or mixture of gases(White ). The Pin Indexed Safety System or PISS is connections intended for supplies of gas that has a gas inlet equipped with a male PISS complement. This safety device is created to avoid leakage through gas inlets that will change the blend of gas delivered to the patient that causes hypoxia.
Bodok seals or a metal with rubber ring seals in the cylinder block ensures that the attachment to PIS is tight enough(Pinnock). The cylinders should be handled with caution and care to avoid accidents that are potentially very serious. The transportation of these cylinders requires three wheeled trolleys that can support the different sizes of cylinders being transported. Suspected cylinders with leaks should be prevented from being transported with the use of a car. Leaking tanks or cylinders with oxygen should be kept from being lifted.
To check for any leaks brush the area with1% TeepolHB7 or other appropriate solutions for detecting leaks and the presence of bubbles will indicated the existence of leaks. Persons that transport cylinders should wear appropriate dress code and have protective clothing to prevent damage to self during accidents. Medical gases are substances that have a great risk for any accidents involve thus persons responsible for manufacturing, transport, sale, handle, and use this must follow rules and regulations.
Life and properties are at stake in accidents that happen due to negligence in doing tasks related to medical gases therefore it is practical to follow regulations strictly. Works Cited Bojanowski , Leszek. “Gas Cylinder Safety. ” 2001. Dosch , Michael P. . “The Anesthesia Gas Machine”. November 11 2007. <http://www. udmercy. edu/crna/agm/03. htm>. FDA , U. S. Food and Drug Administration. “Fda and Niosh Public Health Notification: Oxygen Regulator Fires Resulting from Incorrect Use of Cga 870 Seals”. 2006. November 11 2007. <http://www. fda.
gov/cdrh/safety/042406-o2fires. html>. Lyczko , Edward J. ” The Human Factors of Medical Gas Systems. ” PM Engineer 6. 9 (2000): 34-44. Morgan, G. Edward ; Mikhail, Maged S. ; & Murray, Michael J. Clinical Anesthesiology. Pinnock, Colin A. ; Lin, Ted ; & Smith, Tim, ed. Fundamentals of Anaesthesia. Safety, Iowa State University Environmental Health &. “Gas Cylinder Safety Guidelines”. 1997. <http://www. ehs. iastate. edu/publications/manuals/gascylinder. pdf>. White , Gary C. Basic Clinical Lab Competencies for Respiratory Care: An Integrated Approach.